US5295956A - Endoscopic suction instrument having variable suction strength capabilities - Google Patents

Abstract

An endoscopic suctioning instrument with variable suction is disclosed. The instrument has a hollow cannula having a proximal end and a distal end, and sliding sleeve having a proximal end and a distal end and a longitudinal axis, with the sliding sleeve being coaxial to and closely surrounding and slidingly engaging the hollow cannula. The sliding sleeve has a plurality of lateral holes at its distal end with the lateral holes being spaced along the longitudinal axis. A valve is provided for selectively coupling a suction source to the proximal end of the cannula, and a sleeve actuation mechanism is provided for sliding the sliding sleeve from a first position where the distal end of the sliding sleeve extends beyond the distal end of the cannula such that a first number of the lateral holes are unblocked by said cannula, to a second position where the distal end of the sliding sleeve extends beyond said distal end of the cannula such that fewer lateral holes are unblocked by said cannula, to a third position where the cannula blocks all of said lateral holes of the sliding sleeve. Various embodiments are described with different mechanisms for causing the sleeve to slide, including mechanisms linking the valve to the sleeve.

Description

BACKGROUND OF THE INVENTION

This invention broadly relates to endoscopic instruments. More particularly, this invention relates to a multifunction endoscopic instrument including suction, irrigation and electrocautery means.

Tools having both suction and irrigation features are well known in the art. Perhaps the earliest combination tool of this type is shown in U.S. Pat. Number 1,114,268 to Kells which discloses a "Method For Surgically Cleansing Wounds and Other Surfaces" where an irrigation tube enters a suction tube and the suction tube is covered with gauze or a swab. Irrigation fluid wets the gauze or swab and is sucked back by the suction tube. Rubber hoses may be grasped to control flow. Variations on this type of device include one shown in U.S. Pat. No. 3,810,471 to Truhan which discloses a "Surgical Aspirating Cannula". This is a combined irrigation-suction device where the suction tube is located within and is coaxial with the irrigation tube, and irrigation fluid is delivered in the annular space between the tubes. The distal end of the outer irrigation tube is sealed to the inner suction tube and the irrigation tube is provided with lateral openings. Even more recently, additional features have been added to combined suction-irrigation tools. U.S. Pat. No. 4,617,013 to Betz discloses a "Method and Apparatus For Surgical Irrigation, Aspiration and Illumination" having coaxial fiber optic, aspiration and irrigation tubes.

Tools combining suction and cautery features are also well known in the art and an early tool of this type is shown in U.S. Pat. No. 2,888,928 to Seiger which discloses a "Coagulating Surgical Instrument" where combined cauterizing and suction is provided by a hollow tube cautery probe to which a suction tube is attached. The cauterizing tip is conical with a small opening at the apex of the cone and several lateral openings spaced down from the apex. More recent improvements in this type of tool are shown in U.S. Pat. No. 4,307,720 to Weber which discloses an "Electrocautery Apparatus and Method and Means for Cleaning the Same". This is a combination cautery-suction device where electrode and vacuum tubes are arranged parallel to each other in the same "wand". The electrode is retractable into the wand and retraction of the electrode scrapes the surface of the electrode to clean it. Other variations of this type of tool include yet other features. U.S. Pat. No. 4,207,874 to Choy discloses a "Laser Tunneling Device" which is a probe for a tube such as a blood vessel. The probe includes central fiber optics for illumination, viewing, and laser output surrounded by a coaxial tube with a switchable valve for aspiration or irrigation.

More recently, suction, irrigation, and cautery have been combined in the same tool. U.S. Pat. No. 4,886,491 to Parisi et al discloses a "Liposuction Procedure with Ultrasonic Probe" which includes ultrasonic cautery, suction and irrigation in the same probe.

While many of the tools of the prior art served a purpose at the time they were invented, they are generally inapplicable in today's modern endoscopic surgical procedures. An endoscopic procedure typically involves the use of trocars for making one or more small incisions in the abdomen or chest cavity. Trocar tubes are then left in place in the abdomen or chest cavity so that optical tools may be inserted therethrough for viewing and endoscopic surgical tools may be inserted therethrough for operating. A camera or magnifying lens optical tool is often inserted through the largest diameter trocar tube (e.g. 10 mm diameter) while a cutter, dissector, or other surgical instrument is inserted through a similarly sized or smaller diameter trocar tube (e.g. 5 mm diameter) for purposes of manipulating and/or cutting the internal organ. Sometimes it is desirable to have several trocar tubes in place at once in order to receive several surgical instruments. In this manner, organ or tissue may be grasped with one surgical instrument, and simultaneously may be cut or stitched with another surgical instrument; all under view of the surgeon via the camera in place in another trocar tube.

Those skilled in the art will appreciate that endoscopy is a rapidly growing field of surgery because it is less invasive than classical surgery. However, it will also be appreciated that even with endoscopic surgery where the incisions are typically small, it is advantageous to limit the number of incisions made. The number of incisions must be balanced against the desirability of having several tools inserted and available simultaneously to the surgeon. Likewise, while it is possible to remove endoscopic tools and insert different tools during a procedure, it will be appreciated that repeated insertion and removal of different endoscopic tools through the trocar tubes is preferably avoided, as it can be difficult to locate the new tool at a desired location, and each insertion of a tool increases the risk of unnecessary trauma to the surgical site area.

Some attempts have been made to provide multi-functional endoscopic tools so that the number of incisions may be minimized while at the same time providing the physician with several tools available simultaneously. For example, U.S. Pat. No. 4,708,136 to Saito discloses a "Cautery Hemostatic Unit" which is deliverable through an endoscope and includes an irrigation nozzle. Other combination endoscopic tools are known and generally include combination suction-irrigation and suction-cautery probes. All of these probes occupy a trocar tube when in use and no other tools may be inserted in the trocar when occupied by one of these probes. Additional combinational tools and prototypes recently introduced include tools which have a plurality of different distal end portions which can be attached and removed from a single handle as desired to accomplish different functions. However, this arrangement requires repeated insertion and removal of the endoscopic tool through the trocar tube to the surgical site.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide a multifunction endoscopic instrument which includes suction and irrigation functions.

It is a further object of the invention to provide a suction/irrigation endoscopic instrument where a cautery probe is inserted through the fluid chamber of the instrument.

It is another object of the invention to provide an endoscopic suction/irrigation/cautery instrument which permits the insertion of an additional endoscopic tool through the instrument.

It is also an object of the invention to provide a multifunctional endoscopic instrument having an ergonomic hand piece whereby suction, irrigation and cautery functions are easily controlled.

It is an additional object of the invention to provide an endoscopic instrument having a progressive suction control so that the amount of suction is easily adjustable.

A further object of the invention is to provide an endoscopic suction/irrigation/cautery instrument where the cautery is selectable between cutting and coagulating cautery voltages.

Another object of the invention is to provide a suction/irrigation endoscopic instrument where a distal end probe may be provided in a desired rotational position by insertion of the probe through the instrument and rotation thereof while the instrument stays in place.

An additional object of the invention is to provide a cautery/irrigation safety override mechanism which prevents the application of cautery during an irrigation procedure and thereby protects a patient from burns or shocks resulting from simultaneous irrigation and cautery functions.

Yet another object of the invention is to provide a multifunction endoscopic instrument which includes suction, irrigation, and a removable cautery probe where the cautery probe is lockable in one or more positions within the instrument.

Even a further object of the invention is to provide improved non-leak valves for suction/irrigation endoscopic instruments.

Another object of the invention to provide a T-ball valve for an irrigation system having two fluid sources, where the T-ball valve permits the flow of fluid from either fluid source but automatically prevents backflow from one source to the other.

A further object of the invention is to provide a number of different types of probes which can be inserted into an endoscopic instrument so that suction, irrigation, cautery and selectable other functions are available to the physician through a single trocar tube.

An additional object of the invention is to provide a well-built, relatively inexpensive disposable suction/irrigation/cautery endoscopic instrument.

Another object of the invention is to provide an improved molded two passage suction/irrigation conduit with means for carrying a cautery wire therebetween for the purpose of eliminating cable and conduit tangling.

Another object of the invention is to provide a suction/irrigation endoscopic instrument having tubing already attached to the instrument, and tubing connectors for easy attachment to tubing which extends from suction and irrigation sources.

It is even an additional object of the invention to provide a suction/irrigation endoscopic instrument having an outer sleeve providing a soft distal tip having cleanable side ports.

In accord with the objects of the invention, an endoscopic instrument having both suction and irrigation functions is provided and generally comprises a fluid chamber, a cannula in fluid communication with the distal end of a fluid chamber, a slit valve and an elastomeric gasket in the proximal end of the fluid chamber, irrigation and suction conduits communicating with the fluid chamber between the slit valve and the distal end of the fluid chamber, and valves for selectively opening and shutting off the irrigation and suction conduits. The fluid chamber, slit valve, and the irrigation and suction conduits are located in a pistol shaped shell, and triggers are utilized to actuate the valves which open and shut off the irrigation and suction conduits. Also located inside the shell is an electrical circuits with an electrical contact which contacts a metal portion of the cannula over which an insulating sleeve is provided and which supplies a cauterizing voltage thereto. Different cautery probes are provided. The cautery probes are inserted through the slit valve in the proximal end of the instrument and each cautery probe includes an uninsulated portion which is formed to contact the metal cannula and obtain the cautery voltage therefrom.

There are many preferred aspects of the invention which provide advantageous features. One preferred aspect includes means for regulating the amount of suction through the cannula. The regulating means includes providing the insulating sliding sleeve which covers the cannula with a plurality of longitudinally spaced distal lateral openings, and means for sliding the insulating sleeve relative to the cannula in order to incrementally close the off the lateral openings. Several different mechanisms for causing the sleeve to slide are provided. Another preferred aspect of the invention is a safety cautery/irrigation override mechanism. The override mechanism includes an electrical switch in the irrigation trigger which overrides the supply of cautery voltage to the electrical contact so that no cautery is possible while irrigating. Another safety feature relating to the cautery procedure is a probe arrangement which prevents shocks to the physician. The probe arrangement comprises insulation which shields the probe along its entire length up to the cauterizing distal end except for a segment which contacts the cannula for electrical contact.

With the slit valve and elastomeric sealing gasket at the proximal end of the fluid chamber, fluid is prevented from exiting the proximal end of the chamber but probes or other instruments may be inserted therethrough. For example, besides the cautery probes, irrigation-hydrodissection, injection- aspiration probes, and other probes are provided. One probe includes a tube with lateral holes in communication with the fluid chamber at the irrigation conduit, and an O-ring on the probe for contacting the fluid chamber between the irrigation conduit and suction conduit openings. In this manner irrigation is directed through the probe which extends through the cannula, and at the same time, suction is directed through the cannula and around the probe. If the distal end of the probe is made very small in diameter, the probe may be used for hydrodissection. Many different probes for accomplishing different functions are also provided. All of these probes are inserted through the slit valve in the proximal end of the instrument. The handles of all of the different probes are preferably provided with color coded inserts so that the probe can be identified as to type while it is located within the suction/irrigation instrument.

Besides the ability to insert probes through the slit valve, endoscopic and laparoscopic type instruments with end effectors for grasping, cutting, dissecting, biopsy sampling, etc. may also be inserted therethrough and through the fluid chamber. These instruments may be particularly arranged to include an uninsulated cautery pickup, so that the end effectors can be used for cautery purposes. With the ability to insert such instruments through the slit valve, surgical methods are provided which do not require separate incisions and trocar tubes for suction/irrigation, cautery, and manipulation.

Additional preferred aspects of the invention include: a pinch valve arrangement for the suction and irrigation conduits, including a semicircular hook for collapsing and pinching the conduit against a semicircular protrusion; a pistol shaped shell provided with a rocker thumb switch which controls the selective application of cutting and coagulating voltages to the electrical cautery contact; a special molded "spinal cord" tubing having suction and irrigation conduits which together define a rib indenture into which a cautery wire is snapped so that the the suction and irrigation tubes and cautery wire exiting the suction/irrigation instrument are easily managed; probes with grooves which interact with a locking pin provided in the shell so that probes may be held in an inactive position in the fluid chamber; and a T-ball valve for regulating the irrigation from two fluid sources, where the T-ball valve permits the flow of fluid from either fluid source but automatically prevents backflow from one source to the other. In addition, other embodiments of aspects of the invention are provided, including a fluid chamber with only a single inlet for suction and irrigation, and a trigger mechanism utilizing poppet valves in place of pinch valves to control suction and irrigation.

Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1a is a perspective view of the suction/irrigation instrument of the invention showing the fluid and electrical connections of the instrument with other portions of the invention as well as a cautery probe for insertion into the instrument.

FIG. 1b is a side view of the instrument of FIG. 1a with one half of the instrument shell removed.

FIG. 1c is a detail of an indicated portion of FIG. 1a showing the slit valve and the thumb rocker cautery/coagulation switch.

FIGS. 2a, 2b, and 2c are respectively a partially cut-away side view and side views which show the distal end of the cannula and the sliding sleeve of the instrument of FIG. 1 in first, second and third relative positions which respectively represent a regular suction mode, and first and second "supersuction" modes respectively.

FIGS. 3a and 3b are details of the preferred pinch valve of the invention, showing the pinch valve causing a conduit to be in respectively open and closed positions.

FIGS. 4a and 4b are respectively a side cross sectional view and a top cross sectional view of a preferred fluid chamber for the instrument of FIG. 1a.

FIG. 4c is a detailed view of the cautery electrical contact coupled to the cannula in the fluid chamber of FIG. 4a and 4b.

FIGS. 5a and 5b are cross sectional views of the preferred fluid chamber of the invention with a probe partially and fully inserted therein.

FIG. 5c is a cross sectional view of an alternative probe partially inserted into the fluid chamber of the invention.

FIG. 5d is a cross-sectional view of a locking mechanism for an alternative embodiment for holding a probe in first and second positions in the fluid chamber.

FIGS. 6a, 6b, 6c, and 6d are views similar to FIGS. 5a, but showing different kinds of probes for effecting suction and irrigation in different manners.

FIGS. 7a and 7b show alternate embodiments of suction triggers and mechanisms for activating a "supersuction" mode.

FIG. 8a is a schematic diagram of the electrical circuit incorporated in and coupled to the instrument of the invention, including a irrigation/cautery override mechanism.

FIGS. 8b and 8c are schematic diagrams showing how a portion of the circuit of FIG. 8a is embodied in the shell of the instrument of the invention.

FIGS. 8d-8g show views of a preferred cautery override switch and circuit board used in the electrical circuit of FIG. 8a.

FIGS. 8h-8k show views of a preferred cut/coagulation cautery switch and circuit board used in the electrical circuit of FIG. 8a.

FIG. 9a is a partially exploded cross-sectional view of a first cautery probe.

FIG. 9b is an enlarged view of a portion of of the probe of FIG. 9a.

FIGS. 9c-9f show the distal ends of different types of cautery probes.

FIG. 9g is a cross-sectional through another embodiment of a probe with a mechanism for permitting the probe to be extended out of the cannula and to be withdrawn into the cannula.

FIG. 10a is a schematic views of an endoscopic tool which can be inserted through the suction/irrigation instrument of FIG. 1a.

FIGS. 10b and 10c are respectively a side view in partial cross section, and an enlarged view of the distal end the endoscopic biopsy forceps tool of FIG. 10b which can inserted through the suction/irrigation instrument of FIG. 1a.

FIGS. 11a is a cross-sectional view of a preferred molded tubing having suction and irrigation conduits which together surround a rib indenture into which a cautery wire is held.

FIGS. 11b and 11c are side and cross-sectional views of a connector which mates with the molded tubing of FIG. 11a on the instrument side, and provides for separate suction and irrigation tubes and a loose cautery wire on a second side.

FIGS. 11d is a cross-sectional view of an alternative molded tubing having suction and irrigation conduits which together surround a rib indenture into which a cautery wire is held.

FIG. 11e is a cross-sectional view of a clip for the tubing of FIG. 11a with the tubing held therein.

FIG. 11f is a view of the clip of FIG. 11e in the direction of arrow F thereof.

FIGS. 11g and 11h are perspective views of third and fourth embodiments of the molded tubes having suction and irrigation conduits and a rib indenture for holding a cautery wire.

FIGS. 12a-12e show details of the T-ball valve for use in providing irrigation fluids to the instrument of the invention.

FIGS. 13a and 13b show an alternate embodiment of the fluid port and valve portion of the invention where a single suction/irrigation port is in fluid communication with the fluid chamber, and poppet valves are in respective first and second positions to respectively cause suction and irrigation.

FIG. 13c is a view of FIG. 13a looking in the direction of arrow C thereof.

FIGS. 13d and 13e show a second alternate embodiment of the fluid port and valve portion of the invention where poppet valves are used in conjunction with separate suction and irrigation ports in fluid communication with the fluid chamber.

FIGS. 14a and 14b are cross sections of alternate fluid chambers for use with the fluid port and valve portions of FIGS. 13a and 13d respectively.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring now to FIGS. 1a and 1c, the endoscopic electrosurgical suction-irrigation instrument 100 of the invention is shown having a pistol-shapedshell 102, suction and irrigation trigger switches 104 and 106, irrigation/cautery override switch 107, cautery cut/coag rocker switch 108, andcannula 112. Theinstrument 100 is connected to anelectrical source 150, avacuum source 152 and anirrigation fluid source 154 orsources 154, 156. Aprobe 500, such as an electrosurgical (cautery) probe or the like is shown located outside of theinstrument 100, but intended for insertion by movement as indicated by arrow "A" into and through the instrument.

In the preferred embodiment of the invention, within the pistol shapedshell 102 of theinstrument 100 is a fluid chamber 114 (seen in FIGS. 1b, 4a and 4b). Thecannula 112 is held in thechamber 114 and extends distally therefrom. The proximal end of the fluid chamber is sealed by a slit-valve 118 or the like as described hereinafter. Thus, for effecting cautery or other functions hereafter described, theprobe 500 is inserted through theslit valve 118 and into and through thefluid chamber 114.

With the provided suction-irrigation instrument 100, suction and irrigation are controlled bytrigger switches 104, 106, and cauterization is controlled bythumb switch 108 or by foot switches (not shown) as hereinafter described.Irrigation trigger switch 106 is provided with anelectrical safety override 107 switch which disables thethumb switch 108 when irrigating. Theshell 102 receives asuction vacuum tube 128, anelectrical supply wire 129, and anirrigation supply tube 130 via a "spinal cord" moldedtubing 160 which is discussed in detail below with reference to FIGS. 11a-11d. Two sources ofirrigation fluid 154, 156 may be selectively supplied to theinstrument 100 by using a T-ball valve 158 which is also discussed in detail below with reference to FIGS. 12a-12e.

Turning now to FIG. 1b, theshell 102 can be seen withtrigger switches 104 for suction and 106 for irrigation and a double action orrocker thumb switch 108 for electrosurgical cutting and coagulation (also shown in detail in FIG. 1c). The distal end of thebody 102 is provided with an appropriately sized metal cannula 112 (typically 5 mm or 10 mm) which is covered by an insulating sliding sleeve 110 (described in detail below). The proximal end of thecannula 112 communicates with the distal end of thefluid chamber 114 which is housed within theshell 102. Thefluid chamber 114 terminates at the proximal end of theshell 102 with aslit valve 118 andelastomeric sealing gasket 119. Theslit valve 118 and sealinggasket 119 permit probes of different types including electrocautery probes which are discussed in detail below to be inserted into and through thefluid chamber 114 while still preventing fluid leakage out the distal end of the instrument. More particularly, theslit valve 118 prevents leakage when no probe or tool is inserted therethrough, while the sealing gasket 119 (and to some extent the slit valve) prevents leakage when a probe or tool is inserted through the proximal end of theinstrument 100.

As seen in FIG. 1b, in communication with thefluid chamber 114 are the suction conduit or tube 128 (via suction port 120) and the irrigation conduit or tube 130 (via irrigation port 122). Thesuction conduit 128 extends through apinch valve mechanism 124 and is coupled through atubing junction connector 134 near the base of theshell 102 to the suction portion of thespinal cord tubing 160, and thence to vacuum supply 152 (FIG. 1a). Thesuction valve 124 is operated bytrigger switch 104. As discussed below with reference to FIGS. 7a and 7b, thesuction trigger switch 104 may be divided into twoswitches 104a and 104/104d for controlling normal suction and "super suction". Theirrigation conduit 130 similarly extends through anirrigation valve mechanism 126 and is coupled throughtubing junction connector 134 to the irrigation portion of thespinal cord tubing 160, and thence to irrigation supply 154 (156). The irrigation valve is operated bytrigger switch 106.

Thesuction valve 124 andirrigation valve 126 seen in FIG. 1b are standard type pinch valves, although for larger (e.g., 10 mm) instruments, different pinch valves discussed below with reference to FIGS. 3a and 3b are preferred. Thesuction valve 124 is arranged with astem 171, aspring 172, aspring seat 173, aguide 174, and avalve seat 175. Thestem 171 is coupled to thetrigger 104 and moves with the trigger. The spring sits in thetrigger 104 and is seated on thespring seat 173 which is formed in theshell 102 of theinstrument 100. Thus, as thetrigger 104 is pressed, the trigger is acting against the force of thespring 172 which is being compressed against thespring seat 173. Thestem 171 of thesuction valve 124 is preferably formed as a thin rectangular plastic piece with a large slot (not shown) in the middle which effectively forms a rear hook. The plastic piece is set in theguide 174 formed in theshell 102. In FIG. 1b, thesuction tube 128 is shown extending through the slot in thestem 171 with the rear hook pulling, squeezing, and pinching thetube 128 against theValve seat 175. Because thesuction valve 124 is set forward of the irrigation valve, there is room for theirrigation tube 130 in the handle of the shell when thestem 171 is forced backward inguide 124 to open thesuction tube 128. In other words, with the provided arrangement, thesuction valve 124 does not interfere in any manner with theirrigation tube 130.

Theirrigation valve 126 is similarly arranged to the suction valve, and includes astem 181, aspring 182, aspring seat 183, aguide 184, and avalve seat 185. Thestem 181 is coupled to thetrigger 106 and moves with thetrigger 106. Thespring 182 sits in thetrigger 106 and is seated on thespring seat 183 which is formed in theshell 102 of the instrument. As thetrigger 106 is pressed, the trigger acts against the force ofspring 182. Thestem 181 of theirrigation valve 126 is also preferably formed as a thin rectangular plastic piece with a large slot (not shown) in the middle for forming a rear hook. Care is taken to make the slot large enough to accommodate thesuction tube 128 which also extends through the slot and which must not be pinched when theirrigation valve 126 is actuated. In FIG. 1b, theirrigation tube 130 is shown with the rear hook of thestem 181 pinching thetube 130 against thevalve seat 185. Pressing of thetrigger 106 moves thestem 181 backwards and releases thetube 130 for irrigational flow.

An electrical contact 132 (shown in more detail in FIG. 4) is provided toward the distal end of thefluid chamber 114, for connection with an electrocautery probe as will be discussed in detail below. The electrical signal applied to theelectrical contact 132 is controlled bydouble action switch 108 activated by arocker mechanism 108b which rocks overpivot 108c as described hereinafter with reference to FIGS. 8h-8k. Other aspects of theinstrument 100 seen in FIG. 1b include aprobe locking mechanism 136 described hereinafter with reference to FIGS. 5a-5c; a springbiased mechanism 105a, 105b for moving the insulatingsheath 110 relative to cannula 112 in order to effect supersuction as described in more detail with reference to FIGS. 7a and 7b; aspring mechanism 107a, 107b for activatingcautery override switch 107 as discussed in more detail with reference to FIGS. 8a-8d; and anend cap 116 for the fluid chamber as discussed hereinafter in more detail with reference to FIGS. 4a and 4b.

As shown in FIG. 1b, even without any probe(s) inserted, theinstrument 100 is functional as a suction-irrigation tool. When inserted in the body of a patient, thecannula 112 with insulating slidingsleeve 110 delivers irrigation fluid when theirrigation trigger 106 is squeezed to open the normally closedirrigation valve 126, thereby coupling theirrigation fluid tube 130 withfluid chamber 114 and thus tocannula 112. Similarly,cannula 112 provides suction whentrigger 104 is squeezed and the normally closedsuction valve 124 opens to couplevacuum tube 128 withfluid chamber 114 and thus withcannula 112. Iftriggers 104 and 106 are squeezed simultaneously, the irrigation fluid can be used to clean out a portion of thefluid chamber 114 as well as thesuction port 120 andsuction tube 128.

Turning to FIGS. 3a and 3b, a preferred embodiment of apinch valve 300 used as the suction andirrigation valves 124, 126 of FIG. 1b is seen in the activated open and normally closed positions. Thepinch valve 300 of FIGS. 3a and 3b is used with a resilient conduit or tubing 302 (such assuction tube 128 orirrigation tube 130 of FIG. 1b) and is preferred because it virtually eliminates leakage. In the activated open position of FIG. 3a, flow throughconduit 302 is permitted. In the default or normally closed position of FIG. 3b, no flow is permitted throughconduit 302. As seen in FIGS. 3a and 3b,valve 300 comprises ahook member 304 having a curvedinner surface portion 305 conforming to the outside diameter ofresilient conduit 302, a fixed dome shaped stoppingblock 306 which has a similarly conforming but slightly smaller diameter curvedportion 307, aspring 308, and anactuator 310. In the normally closed position of FIG. 3b (also shown in FIG. 1b) thehook 304 is biased byspring 308 to press inward againstdome block 306, whereby theresilient conduit 302 is collapsed and pinched in a curved manner assuring a virtually complete stoppage of flow through theconduit 302. However, when theactuator 310 is squeezed against the force ofspring 308, thehook 304 moves away from the dome block 306 (which is fixed in position), as thespring 308 is compressed. With thedomed block 306 no longer squeezing theresilient conduit 302, theresilient conduit 302 resumes its normally round and open position as shown in FIG. 3a.

Those skilled in the art will appreciate that theactuator 310 of FIG. 3a is coupled to triggerswitches 104, 106 discussed with reference to FIG. 1b. In addition, the preferred embodiment ofpinch valve 300 is useful primarily when thetubes 302 are of sufficiently large diameter so as to readily collapse into an arcuate shape as suggested by FIG. 3b. With tubes of small diameter, a standard pinch valve is best used since small tubes cannot readily be folded into the FIG. 3b configuration. In either case, however, it is desirable that thetubes 302 have a relatively thick resilient wall. In this manner, whensuction trigger switch 106 is squeezed, the trigger will travel enough distance to activatesafety override switch 107 before thevalve 300 permits fluid to flow through the tube 302 (130 in FIG. 1b). In other words, the resilient tube should be thick enough so that theoverride switch 107 is activated while the tube is decompressing as opposed to the walls of the tube separating from each other. This feature will be discussed in more detail below in reference to FIGS. 8a-8d.

Details of thefluid chamber 114 ofinstrument 100 are seen with reference to FIGS. 4a and 4b. In the preferred embodiment of the invention, thesuction conduit 120 is located downstream (distal) of theirrigation conduit 122, and the internal diameter of thefluid chamber 114 is larger in the vicinity of the suction and irrigation conduits (114a) than it is at 114b in the vicinity of thecannula 112. One purpose of providing a narrowing fluid chamber is to provide a seat against which the probes can stop. Another reason is to accommodate O-ring washers which form parts of some of the probes of the invention as will also be discussed in detail below. However, it should be appreciated that it is not necessary that the fluid chamber narrow in the way shown in FIGS. 4a and 4b, or that the suction conduit be located distal of the irrigation conduit. Indeed, the fluid chamber can be constructed of a constant diameter, and the conduits reversed.

As seen in FIGS. 4a and 4b, the proximal end offluid chamber 114 is covered with anend cap 116 which houses aslit valve 118 and anelastomeric sealing gasket 119 as previously mentioned. Theend cap 116 is formed to mate with the proximal end of thefluid chamber 114. The function of theend cap 116 is to permit theslit valve 118 and sealinggasket 119 to be inserted into the proximal end of the fluid chamber during assembly, and to be held there during use of the instrument. Also preferably located at or near the proximal end of thefluid chamber 114 or at theend cap 116 is a spring biasedlocking pin mechanism 136. Lockingpin mechanism 136, as seen in more detail in FIG. 1b, preferably includes a pin 136a having anengaging end 136b, a circumferential flange extending around thepin 136c, astop 136d extending from theshell 102, and aspring 136e which is loaded between thestop 136d and theflange 136c. As will be discussed in more detail hereinafter, the locking pin 136a is spring biased in a position toward thefluid chamber 114 and is used to releasingly mate with at least one detent on a probe so that the probe can be held in a retracted position within thefluid chamber 114.

Located toward the distal end of the fluid chamber is theelectrical contact 132 which is shown in more detail in FIG. 4c. The electrical contact preferably comprises awasher 132a which is insert molded into thefluid chamber 114. Thewasher 132a hasridges 132b and atab 132c. Theridges 132b are used to make electrical contact with themetal cannula 112, and thetab 132c is used for electrical connection to a wire coupled to a current source as discussed in more detail hereinafter with reference to FIGS. 8a-8c.

FIGS. 5a and 5b show a probe such as ahydrodissection probe 500a which is held in two different positions influid chamber 114. Thehydrodissection probe 500a is provided with a closed endproximal handle portion 502 from which ashaft portion 504 extends. Theshaft portion 504 is provided withlateral holes 506 and alongitudinal bore 507 extending from theholes 506 to thehollow rod 510 which extends through thecannula 112. Thelongitudinal bore 507 and thehollow rod 510 are in fluid communication. While the distal end ofprobe 500a may be configured in a number of ways as will be described in detail below with reference to FIGS. 9a-9f, in order to be a hydrodissection probe, thehollow rod 510 ofprobe 500a should be extremely narrow in cross-section and should have adistal opening 512 at the tip of thehollow rod 510. Also, to enable theprobe 500a to provide a cautery function, thehollow rod portion 510 is provided with anuninsulated bump 511 which contacts cannula 112 (when the probe is in the position shown in FIG. 5a), and a distaluninsulated cauterizing surface 514. In this manner, theuninsulated bump 511 makes electrical contact with the cannula 112 (which is provided with current via contact 132) and conducts the current to thedistal cauterizing surface 514.

In accord with a preferred aspect of the invention, the probe is also provided with one ormore detents 518 and 520 into which engageprobe locking pin 136 can engage. As shown in FIG. 5a, when theprobe 500a is fully inserted into thefluid chamber 114 so that lockingpin 136 engages detent orgroove 520, the O-ring 508 aligns itself between theirrigation port 122 and thesuction port 120. As shown in FIGS. 5a and 5b, the outer diameter of thehollow rod portion 510 of the probe is much smaller than the inner diameter of thecannula 112 with anannular space 516 being established therebetween. Thus, two fluid paths are established. In particular, the O-ring divides thefluid chamber 114 into two portions, with a first portion located between theslit valve 118 orgasket 119 in theend cap 116 and the O-ring 508, and the second portion located between the O-ring 508 and thecannula 112. The irrigation fluid supplied throughirrigation port 122 is trapped between the slit valve and the O-ring in the first portion offluid chamber 114 so that it is forced intolateral holes 506 where it is communicated through the interior of the shaft of the probe to thedistal end opening 512. Suction applied throughsuction port 120 to the second portion of thefluid chamber 114, however, is directed by the O-ring to theannular space 516 between thesmaller diameter portion 510 andcannula 112. Thus, suction and irrigation may be accomplished at the same time. Also, as thebump 511 on the hollow rod is contacting the metal cannula, cautery and suction may be accomplished at the same time. Irrigation and cautery, however, cannot be accomplished simultaneously due to the cautery/irrigation override arrangement discussed hereinafter with reference to FIGS. 8a-8c.

It will be appreciated that theprobe 500a may be withdrawn to a second position shown in FIG. 5b where locking pin engagesdetent 518. In this position, while a cautery connection is made betweenbump 511 andcannula 112, a cautery procedure cannot be carried out, as the distal end of the probe no longer extends through the distal end ofcannula 112. However, because the detents are located close to each other, the O-ring 508 still separates the fluid chamber into two portions, and irrigation may continue through thehollow rod 510, and suction may continue through theannulus 516. In addition, since the probe is in place, it is readily available for use by pushing it forward to the position shown in FIG. 5a.

In FIG. 5c, a modified cautery probe is shown so that thefront locking detent 518a is located substantially distal the rear detent (not shown in FIG. 5c). In this situation, when the cautery probe is pulled backward until lockingpin 136 engages thedetent 518a, thebump 511 on the probe does not contact the cannula, and cautery cannot be conducted because the probe no longer extends through the distal end of thecannula 112 and because no electrical contact is made. In addition, irrigation and suction cannot be accomplished at the same time, as the O-ring 508 no longer separates the fluid chamber into two portions. However, with this arrangement, if the suction and irrigation triggers are activated at the same time, as previously described, a cleaning of the fluid chamber can be effected.

Those skilled in the art will appreciate that if desired, the functions discussed above with reference to FIGS. 5b and 5c can be combined by providing the probe with bothdetents 518 and 518a, so that two stops are provided at different locations. Also, it will be appreciated thatdetent 520 is not necessarily provided, as thehandle 502 can act as a stop for the fully inserted position.

While the locking pin mechanism of FIGS. 5a-5c is shown schematically, it will be appreciated that thelocking pin mechanism 136 of FIG. 1b is preferred. With that arrangement, as theprobe 500a is inserted into the fluid chamber, thehollow rod 510 will extend past the locking pin mechanism without touching it. However, as the shaft enters the end cap area, the taper on the distal end of the shaft will contact the locking pin 136a and the locking pin will ride up and along the shaft and intodetent 518. Thedetent 518 and theend 136b of the locking pin 135a are preferably shaped and formed in certain manners as discussed hereinafter with reference to FIGS. 9a and 9b so that it is relatively easy to move theprobe 500a forward so as to disengage the locking pin 136a from thedetent 518 upon forward movement. Forward movement to the forward position causes the pin 136a to once again ride on the shaft of theprobe 500a. If asecond detent 520 is provided for the most forward position of the probe, the pin 136a will engage in that detent. When theprobe 500a is moved backward towards its retracted position, the pin 136a rides along the shaft surface and again engagesdetent 518. However, this time, because of the hereinafter described arrangements of thedetent 518 and the locking pin 136a, additional backward movement is more difficult; i.e., the lock is a better lock and requires more force. In this manner, the practitioner is made aware that theprobe 500a is in the retracted position, and a stable retracted position is established.

FIG. 5d shows an alternate embodiment of the locking pin mechanism. In the embodiment of FIG. 5d, pulling on the probe will not release the probe from the locking pin. Rather, the lockingpin mechanism 536 requires an active release. In particular, the locking pin mechanism of FIG. 5d, includes alocking pin 536a with aflange 536b andtab 536c, aspring 536d, a stationary spring stop orhousing 536e, alever 536f, alever pivot 536g, and abutton plunger536h having flange 536i. With the provided arrangement, thelocking pin 536a is spring biased by thespring 536d (which sits betweenhousing 536e andtab 536c) so that the end of thelocking pin 536a extends throughhousing 102 and can engage a detent in a probe. Theflange 536b on thelocking pin 536a stops the locking pin in a defined position. When thelocking pin 536a is locked in a detent or groove of a probe, pushing on theplunger 536h (which also extends out of housing 102) releases the probe. The probe is released, because by pushing onlever 536f, thelever 536f rotates aroundpivot 536g, and pushes thelocking pin 536a upwards by itstab 536c against the force of thespring 536d. Upon release ofplunger 536h, thespring 536d forces the lockingpin 536a downward until the pin is stopped byflange 536b. Likewise,lever 536f is pushed in the opposite direction, and pushesbutton plunger 536h upward until it is stopped byflange 536i.

Because thelocking pin 536a is preferably angled at itstip 536j, and the detent (as seen in FIG. 9a) of the probe is preferably similarly ramped as it extends in a proximal direction, as the probe is pushed into the instrument, thelocking pin 536a rides on the shaft, and into and out of the detent. Upon trying to remove the probe from the instrument, the blunt face oftip 536j will engage a shoulder on the detent, and removal by pulling on the probe will not be effective. Removal is only obtained by activation ofplunger 536h.

FIGS. 6a through 6d show some of the different types of probes which can be used with the instrument of the invention. In particular, and with reference to FIG. 6a, aprobe 600a which is similar to probe 500a (FIGS. 5a and 5b) is shown, but two sets oflateral holes 606a, 607a, two O-rings 608a, 609a, and aninner tube 605a with adistal port 613a are provided. With the two O-rings, three chambers are established, with a distal chamber forward the O-ring 609a, a suction chamber between O-rings 609a and 608a, and an irrigation chamber proximal O-ring 608a. As shown in FIG. 6a,holes 607a in the probe communicate with the interior of hollow rod ortube portion 610a of the probe which extends throughchamber 112. Thus, suction is accomplished throughtube 610a, holes 607a and intosuction port 120. Holes 606a, on the other hand, communicate with theannular space 616a in thecannula 112 viatube 605a Which extends through the suction chamber and Opens at 613a into theannular space 616a. Thus, in thisprobe 600a as compared to theprobe 500a of FIGS. 5a and 5b, suction is applied through the smaller diameter portion ofprobe 610a and irrigation is supplied through theannular space 616a; which arrangement is the opposite of what is obtained in FIG. 5a.

FIG. 6b shows yet another kind ofprobe 600b. In this probe, suction and irrigation are both applied through the distal opening 612b of theprobe 600b.Probe 600b is provided withlateral holes 606b communicating with the interior of the probe to the opening 612b at its distal end. O-ring 708b seals thefluid chamber 114 from theannular space 616b betweenprobe 600b andcannula 112. Both suction and irrigation are provided throughholes 606b to the opening 612b at the distal end ofprobe 600b.

FIG. 6c shows an additional feature which can be utilized in conjunction with any of the previously described probes. In particular, aprobe 600c is shown (similar to probe 500a of FIG. 5a) with alongitudinal bore 607c which extends all the way through theshaft 604c and handle 602c. Blocking thelongitudinal bore 607c in the handle (although it could be placed in the shaft) is aslit valve 625c. As shown in FIG. 6c, another probe, such asneedle probe 689c, is inserted through thehandle 602c, theslit valve 625c, thelongitudinal bore 607c and into thehollow rod 610c.Probe 689c is typically longer thanprobe 600c so that when inserted inprobe 600c, its distal end 691c extends through and beyond theopening 612c at the distal end ofprobe 600c. The proximal end ofprobe 689c is preferably provided with a female luer slip orluer lock 699c for receiving a syringe. With the provided arrangement, should an injection of medicine through theinstrument 100 be desired, or should a fluid sample be required, a syringe can be coupled to theluer lock 699c, and the medicine injected or fluid aspirated into the syringe. After the injection or aspiration procedure, theneedle probe 689c can be removed, and theprobe 600c can remain in place without leakage out the proximal end because of theslit valve 625c. Likewise, before theneedle probe 689c is inserted through the slit valve, and while the needle probe is extending through the slit valve, no leakage will occur even if suction or irrigation is occurring at the same time. It will be appreciated, that if desired, a gasket (not shown) can also be used in conjunction with theslit valve 625c in the handle of thetool 600c such that the arrangement will be similar to the proximal end of the fluid chamber. Also, it will be appreciated that theprobe 600c can take many forms, with or without lateral ports (shown in phantom) and with or without O-rings as discussed above with reference to FIGS. 5a-5c. The O-rings could serve both to center theprobe 600c and to separate the irrigation and suction ports.

FIG. 6d shows yet another kind ofprobe 600d which has some functional similarity to theprobe 600c of FIG. 6c. Inprobe 600d, a fluid path 607d is provided through thehandle 602d andshaft 604d and out through thehollow rod 610d to thedistal opening 612d, and aslit valve 625d and aluer lock 699d are provided at the distal end of theprobe 600d. If desired, medication can be injected through theprobe 600d, or fluids can be sucked through the probe by coupling a syringe (not shown) to theluer connector connector 699d, with the nose of the syringe (not shown) extending through theslit valve 625d. By requiring the nose of the syringe to extend through theslit valve 625d, the syringe will be in fluid contact with the fluid path 607d in theshaft 604d. It will be appreciated that if theprobe 600d is made sufficiently narrow, both suction and irrigation can be accomplished via the annulus established between the probe and the fluid chamber (and probe and cannula). If it is desired to have theprobe 600d only permit suction besides its medicating and aspirating functions, an O-ring can be provided between the suction and irrigation ports.

It will be appreciated by those skilled in the art that yet other probes can be provided with the provided instrument. For example, a sharp trocar (e.g., a pyramidal metal trocar--not shown) can be formed as a probe and can be inserted and locked into place (as discussed above with reference to FIG. 5c or otherwise) ininstrument 100 so that thesleeve 110 can act as the trocar tube. Theinstrument 100 with such a trocar probe in place can then act as a trocar which is used to make a trocar incision through the skin and fascia of a patient, and into a body cavity. Once the incision is made, the trocar probe can be released and removed, and the suction/irrigation instrument 100 can be used as aforedescribed, with probes and/or laparoscopic and endoscopic instruments (discussed below with reference to FIGS. 10a-10c) being inserted therethrough, except that instead of operating through a trocar tube, thesleeve 110 acts as the trocar tube. With such an arrangement, it may be desirable to eliminate the holes in the distal end of thesleeve 110. Likewise, it may be desirable to fix thesleeve 110 relative to the metal cannula such that thesleeve 110 cannot be retracted and rub against the incision. Other arrangements, such as providing the instrument with an extra tube (not shown) outside thesleeve 110 which acts as the trocar tube, etc. will suggest themselves to those skilled in the art.

As mentioned above in reference to FIG. 1b,trigger switch 104 may be divided into twoportions 104a and 104/104d which control suction and "super suction". Three different embodiments for providing the "super suction" feature are seen in FIG. 1b, FIG. 7a and FIG. 7b, and all may be understood with further reference to FIGS. 2a, 2b, and 2c.

FIGS. 2a and 2b show the distal ends ofcannula 112 and sliding sleeve 11? in cross section. FIG. 2a shows the default position ofcannula 112 and slidingsleeve 110 when no trigger switches are being pulled. In FIG. 2a, it is seen that suction may occur through all of theholes 111 in the sliding sleeve. Material sucked therethrough then proceeds through the distal opening in the cannula, as there is no annulus between the cannula and the sliding sleeve (i.e., they are in sliding contact with one another). FIG. 2b shows an intermediate position, where slidingsleeve 110 is retracted such that at least onehole 111 in the slidingsleeve 110 is blocked by thecannula 112, but suction can be obtained through other holes therein. FIG. 2c shows a full "super suction" position, where the slidingsleeve 110 is completely retracted such that all of theholes 111 in the slidingsleeve 110 are blocked by thecannula 112, and suction is only through the distal opening in thecannula 112.

As previously mentioned, the distal end of slidingsleeve 110 is provided with a plurality oflateral holes 111. Whensleeve 110 is in the position shown in FIG. 2a, the suction vacuum appearing at the distal tip ofcannula 112 is diffused. Whensleeve 110 is pulled back to the position shown in FIG. 2c, the lateral holes 111 ofsleeve 110 are blocked and can no longer provide suction openings. Thus, the entire suction vacuum appears at the distal tip ofcannula 112 to effect "super suction". It will be appreciated that assleeve 110 slides overcannula 112, holes 111 will at different positions (e.g., FIG. 2b) have incremental effects on the suction at the distal tip ofcannula 112. Thus, the operation of the "super suction" feature of the invention is incremental and as the super suction trigger is pulled, suction gradually increases until a maximum is reached.

The preferred embodiment for generating the super suction function is shown in FIG. 1b. In this embodiment, the slidingsleeve 110 is provided with acollar 105a which is directly coupled to a super suction trigger 104a. Thecollar 105a is spring loaded byspring 105b so that in the default position, thesleeve 110 assumes the position as shown in FIG. 2a, and the trigger 104a is located distally relative to anextension 104d on thesuction trigger 104. With this arrangement, slidingsleeve 110 can be moved a certain amount by pulling trigger 104a without engagingsuction trigger 104. This may be desirable in order to clean debris which may accumulate at the distal end of slidingsleeve 110. Continued movement of trigger 104a backward, however, will eventually cause the super suction trigger 104a to engage theextension 104d oftrigger 104, thereby automatically activating suction. On the other hand, thesuction trigger 104 can be activated without activation of the super suction trigger 104a.

A second super suction embodiment is seen with reference to FIG. 7a. In FIG. 7a, the supersuction trigger switch 704a is coupled to ahook 705 which engagescollar 705a of slidingsleeve 110. As with the embodiment of FIG. 1b, thecollar 705a is spring biased by aspring 705b. The supersuction trigger switch 704a is also provided with an extendingportion 704c which extends over thesuction trigger 704b. In this manner, the action of pullingtrigger switch 704a, which pulls backcollar 705a againstspring 705b, always causes slidingsleeve 110 to slide backward (as seen in FIGS. 2b and 2c) while at the same time causingtrigger switch 704b to opensuction valve 124. As with the arrangement of FIG. 1b, the pulling oftrigger switch 704b will not cause thesuper suction trigger 704a to be activated.

A third embodiment of super suction can be effected without dividing the trigger switch into two portions as shown in FIGS. 1b and 7a. In FIG. 7b, thetrigger switch 704 is attached to anactuator mechanism 759 having twoextensions 759a and 759b which are spaced apart andsurround collar 705a with a gap being formed betweencollar 705a and extension orhook 759b. Thecollar 705a is attached to the proximal end of thesleeve 110 and is spring loaded byspring 705b. In the embodiment of FIG. 7b, whentrigger 704 is pulled through a distance equal to the gap betweenhook 759b andcollar 705a, the suction valve is opened, but the slidingsleeve 110 is not pulled. Additional squeezing oftrigger 104 beyond that point, however, causeshook 759b to engagecollar 105a andslide sleeve 110 back againstspring 105b causing super suction. Thus, with the embodiment of FIG. 7b, full suction can be obtained by squeezingtrigger 704 a first amount (fully opening the valve), while super suction is obtained by squeezingtrigger 704 even further to cause movement ofsleeve 110 after the valve is fully opened.

FIG. 8a shows a block diagram of the electrical circuit used with the instrument to power an electrosurgical probe. Anelectrical source 150 supplies two different DC voltages throughconductors 129a and 129b to a three position (A-OFF-B)switch 108 which selects either voltage A orvoltage B. Switch 108 supplies the selected DC voltage throughconductor 129d tosafety switch 107 which is normally closed and thereby supplies the voltage throughconductor 129e toelectrical contact 132 and back toelectrical source 150 viaconductor 129c.Electrical source 150 then senses which DC voltage was selected and supplies the appropriate AC voltage for cutting or coagulating viaconduit 129c back toelectrical contact 132 whereby an electrosurgical probe receives the selected voltage. As seen in FIG. 1b, thesafety switch 107 is opened wheneverirrigation trigger 106 is pulled, asspring 107a, which is fixed to theirrigation trigger 106 atpoint 107b, and anchored to the housing at 107c, is provided with anactuation portion 107d which moves off ofdome switch 107 whenspring point 107b is moved. Thus, cautery is interrupted during irrigation. In this regard, it is recommended that the valves discussed above with reference to FIGS. 3a and 3b and also discussed below with reference to FIG. 13 be provided with a certain amount of travel before irrigation is actuated. This will ensure that the safety switch is opened before any irrigation fluid is allowed to flow through the irrigation valve. Moreover, it should be noted that this arrangement of theelectrical source 150 andconductors 129a-e ensures that the actual AC cautery voltage does not pass through theswitches 107, 108, thereby minimizing the risk of shock to the physician and switch failure. Such electrical sources which are activated by DC voltage to send a selected AC voltage are known in the art.

FIGS. 8b and 8c show examples of how this circuit is implemented in the shell of the instrument. Turning to FIG. 8a, anelectrosurgical power supply 150 provides two sources of DC voltage throughconductors 129a and 129b. These voltages are selectively applied to theelectrical source 150 viaconductor 129c by a threeposition switch 108 which in FIG. 8b is arocker switch 108b.Switch 108 selects the desired voltage and conducts that voltage throughconductor 129d tosafety switch 107 which is normally closed but is opened by pulling theirrigation trigger 106.Safety switch 107, when closed, couplesconductor 129d,electrical contact 132 throughconductor 129e, andelectrical source conductor 129c.Electrical source 150 then senses which DC voltage was selected byswitch 108 and supplies the appropriate AC cautery voltage throughconductor 129a, switch 107 andconductor 129e toelectrical contact 132 and thereby to an electrosurgical probe inserted in theshell 102.

FIG. 8c shows a similar arrangement to FIG. 8a, but with astandard foot switch 108a and a providedadapter 108c substituted for thethumb switch 108 of FIG. 8a and 8b. As seen in FIG. 8c, the standardelectrosurgical power supply 150 is provided with four output ports: a first port for a "cut"low voltage wire 129a; a second port for a "coag"low voltage wire 129b; a third port for a "common"wire 129e; and a fourth port for the high voltageAC signal wire 129c. Likewise, thestandard foot switch 108a is provided with three ports, including the "cut" port, the "coag" port, and the "common" port. The primary difference between the electrical arrangement of FIG. 8c and that of FIGS. 8a and 8b is that in FIG. 8c, the low voltage DC cut or coag signal is not sent over the same wire as the AC signal. Thus,wire 129 c is connected directly from thepower supply 150 to the cannula, and theadapter 108c is provided to interrupt thecommon wire 129d/129e, so that it is routed through the cauteryoverride safety switch 107. Whenswitch 107 is closed, and either the cut or coag foot switch is pressed, a DC circuit is completed frompower supply 150, throughwire 129a or 129b (viaadapter 108c), throughwire 129d (viaadapter 108c), throughswitch 107, throughwire 129e (viaadapter 108c) and back to thepower supply 150. The closed circuit signals thepower supply 150 to provide an appropriate AC signal to the cannula of the instrument viawire 129c. However, whenswitch 107 is open, the DC circuit cannot be completed, and hence no high voltage AC signal will be sent out overwire 129c.

While not preferred, it will be appreciated that in either of the disclosed arrangements, switch 107 can be located in theAC path 129c instead of the DC path. Such an arrangement guarantees that the voltage/current source 150 cannot malfunction and supply current via theAC path 129c to the cannula when no DC voltage is being presented. On the other hand, such an arrangement places greater electrical demand onswitch 107 asswitch 107 must interrupt the high voltage AC current.

FIGS. 8d-8k show preferred embodiments dome type switches which can be used for thethumb switch 108 andsafety switch 107 described above. In particular, FIGS. 8d and 8e represent respectively a top view and a bottom view of a printedcircuit board 830 used in connection with dome-type safety switch 845 shown in FIGS. 8f and 8g. This switch may be used for safety switch 107 (FIG. 1b).Circuit board 830 includes wire holes 832, 834 for attaching electrical wires.Wire hole 832 is surrounded byconductive material 836 forming a circular strip surrounding but insulated from a smallerconductive circle 838. In FIG. 8e it can be seen that the smallconductive circle 838 is coupled byconductive material 838a throughconductive strip 840 towire hole 834.

FIG. 8f shows a top view ofdome switch 845 having adome 842. As will be appreciated,dome 842 is constructed of resilient material and is conductive on its side facing the top ofcircuit board 830 so thatpressing dome 842 electrically couples theconductive material 836 and 838 thereby coupling wires attached to wireholes 832 and 834. Referring once again to FIG. 1b, it can be seen that a dome type switch such as the one described above my be used forsafety switch 107 wherein a biasingmember 107a such as a spring keepsswitch 107 normally closed and where the biasing member has an engagingportion 107b which is moved bytrigger 106 so as to moveactuation portion 107d and open theswitch 107.

FIGS. 8h and 8i are respectively a top view and a bottom view of a printedcircuit board 850 used in connection with dome-type rocker switch 880 shown in FIGS. 8j and8k. Circuit board 850 includes wire holes 852, 854, and 856 for connecting to electrical wires.Wire hole 854 is surrounded byconductive material 864 which is a straight strip connecting two circular strips ofconductive material 868 and 870. These circular strips surround smallerconductive circles 872, 874. A singleconductive strip 876 surrounds wire holes 858. In FIG. 8i it is seen thatwire hole 852 is surrounded byconductive material 878 which connects withconductive material 874a and 874 on the top side of the circuit board. Similarly,wire hole 856 is surrounded byconductive material 876 which connects withconductive material 872a and 872 on the top side of the circuit board.

FIG. 8j shows a top view of thedome switch 880 havingdomes 882 and 884. As will be appreciated, domes 882 and 882 are constructed of resilient material and are conductive on their side facing the top ofcircuit board 850 so thatpressing dome 882, for example, electrically connectsconductive material 868 and 872 thereby coupling the cautery wires connected to wireholes 854 and 856. Similarly,pressing dome 884 results in a coupling of conductors connected to wireholes 854 and 852. Wire holes 858 are provided as a simple hardwire connected means to couple three conductors. Referring once again to FIG. 1b, it can be seen how a two-dome-type switch such as the one described above can be used forthumb switch 108 wherein arocker arm 108a pivots at 108b to depress either one of the domes described above.

As mentioned above, many different kinds of probes can be used with the instrument and more than one probe can be used together in the instrument. FIGS. 9a-9g show additional features of probes used with the instrument.

FIG. 9a shows a side cross sectional view of acautery probe 900. The probe comprises ahandle 902, from which extends ashank 904 which carries the probe wire orconductor 906. Handle 902 is provided with arecess 902a for receiving a color codedinsert 903 which snaps in place. In this manner, the distal arrangement of the probe can be quickly identified by the physician during an operation either while the probe is in place, or in choosing a probe. Theshank 904 is provided with at least onelocking groove 918 to secure the probe in the instrument as discussed above in reference to FIGS. 5 and 6, although asecond groove 920 may also be utilized. Theprobe conductor 906 is provided with a bumpedportion 911 for engaging the electrifiedcannula 112 as discussed above, and terminates with acauterizing surface 912 which may be configured in a number of ways. Theprobe conductor 906 is insulated with insulatingsleeve 908 along its entire length except for the bumpedportion 911 and thecauterizing surface 912. Preferably, the bumpedportion 911 is located near the distal end of the probe to add stabilization to the probe. However, if desired, in accord with another embodiment of the invention, theinstrument 100 is not provided with a metal cannula and a sleeve, but with only a smooth nonconductive sleeve which acts as the cannula. With this arrangement, the bumpedportion 911 ofprobe 900 is provided close to the shank of the probe at the location of the washer 132 (FIG. 4) so that the bumpedportion 911 contacts thewasher 132 to obtain its electrification.

Referring now to FIG. 9b, theshank portion 904 of theprobe 900 is seen in an enlarged view. As shown in FIG. 9b, and previously discussed with reference to FIGS. 5a-5c, the locking groove ordetent 918 inprobe shank 904 is configured such that it engages and easily disengages thelocking pin 136 when the probe is inserted, but does not as easily disengage when the probe is being withdrawn from the fluid chamber. In particular, lockinggroove 918 has afirst ramp 918a of decreasing diameter as it extends distally, followed by a section ofconstant diameter 918b followed by a sharply angled ramp orstep 918c of increasing diameter. By forward movement of theprobe carrier 904, the locking pin rides on the outer surface of the probe. Upon reachinggroove 918, the locking pin snaps into the groove. Continued movement causes the pin to ride up the gentle slope of theproximal ramp 918a and to continue riding on the outer surface of theprobe shank 904. Upon rearward movement of the probe, however, the pin located in thegroove 920 and establishes a stable intermediate position for the probe. If it is desired to remove the probe, the pin must be forced over the step or sharplyangled ramp 918c. It will be appreciated by those skilled in the art that locking groove(s) 918 (and 920) and/or lockingpin 136 may be configured in different ways to give probes a different feel when engaginglocking pin 136.

As mentioned above, thecauterizing surface 912 of theprobe 900 may be configured in a number of ways.Surface 912 in FIG. 9a is a ball shaped tip. FIGS. 9c-9f show respectively a hook 912a, an L-hook 912b, aspatula 912c and aspoon 912d. Other configurations will be obvious to those skilled in the art. The color codedinserts 903 mentioned above are preferably used as a rapid means of distinguishing these probes when the probe is inserted in the instrument and not in view, or when many of the probes are laying together on a tray.

FIG. 9g shows another kind ofprobe 901. This probe has aretractable probe conductor 906 which is slidably mounted inside ahollow opening 925 ofprobe shank 924.Probe conductor 906 is provided with aproximal handle 930 which is biased byspring 926 to a position whereinprobe conductor 906 is somewhat retracted insideprobe shank 924. Probehandle 902 is provided with ahollow opening 927 which receives theproximal handle 930 and amovable pin 928 biased radially outwards byspring 929.Proximal handle 930 is provided withlateral openings 932 through whichpin 928 passes in part but is stopped bypin stop 931 andlateral opening 932 is provided at its proximal end with a pinstop engaging recess 933. As shown in FIG. 9g, theprobe conductor 906 is retracted, andproximal handle 930 is biased outward from probe handle 902 andpin 928 is biased radially out ofprobe opening 932. By pressingproximal handle 930 forward intoprobe handle 902,probe conductor 906 is moved in the distal direction out from its retracted position shown. As a result,spring 926 is compressed, and inner surface oflateral opening 932 rides on top ofpin stop 931 untilpin stop 931 is positioned above pin stop engagingrecess 933. At this point, pin 928 moves radially outward under the action ofspring 929 and pin stop 931 engages pin stop engagingrecess 933 whereby the position ofproximal handle 930 is locked againstspring 926 and theprobe conductor 906 is locked in an extended position. It will be appreciated that the retraction of theprobe conductor 906 may be simply effected by pressingpin 928 at its top portion which extends radially throughprobe handle 902, thereby disengaging pin stop 931 from pin stop engagingrecess 933 and allowing action ofspring 926 to biasproximal handle 930 back to the position shown in FIG. 9g. It will be appreciated, that in order to avoid entry of fluid into theprobe 901, afluid seal 935 such as an O-ring is provided in theshank 924. The seal contacts theprobe conductor 906, but permits theprobe conductor 906 to extend therethrough.

As mentioned above, in addition to the probes specifically designed for use with the instrument, many existing endoscopic tools can be used in conjunction with the instrument and other tools may be modified for use with the instrument. For example, FIGS. 10a-10c show details of endoscopic tools from coassigned U.S. patent applications Ser. Nos. 07/780,013 and 07/837,046, both of which are incorporated herein by reference in their entireties.

With reference to FIG. 10a, a laparoscopic surgical tool is indicated at 1000. The laparoscopicsurgical tool 1000 includes analuminum tube 1015 surrounded by a peripheral insulating shrink Wrap layer of plastic 1020, a clevis means 1030,end effectors 1040, actuating means 1050, and apush rod 1060. The clevis means 1030 is preferably a separately formed aluminum piece which fixedly engagesaluminum tube 1015. Theclevis 1030 also engages the manipulatingmembers 1090, 1092 of theend effector 1040.Members 1090 and 1092 are pivotally engaged toclevis 1030 atpivot pin 1045. Thepush rod 1060 is engaged at itsdistal end 1065 to the manipulatingmembers 1090, 1092, and is connected at 1070, at its proximal end, to a manually operable actuating means 1050. As seen in FIG. 10a, (as opposed to Ser. No. 07/780,013)instrument 1000 is modified in that abump 1011 in thealuminum tube 1015 is provided to make contact withcannula 112 shown and described above, and in that theinsulation 1020 is discontinued at the bump.

In use, thelaparoscopy tool 1000 is inserted with theblades 1090, 1092 of theend effector 1040, in the closed position, through the elastomeric gasket and slit valve and into the fluid chamber and cannula of instrument 100 (shown and described above). Upon the distal portion of thelaparoscopy tool 1000 exiting the cannula ofinstrument 100, one or both of theblades 1090, 1092 can be opened and closed as indicated by reciprocal motion ofpush rod 1060 which results from operation of the manual actuating means 1050, and thelaparoscopy tool 1000 may be rotated as desired. If the laparoscopy tool is sufficiently small in diameter relative to the cannula, suction and irrigation are still available through thecannula 112. In addition, because ofbump 1011, a cautery voltage may be selectively applied to the end effector of thelaparoscopy tool 1000 throughelectrical contact 132 andcannula 112. Further, thelaparoscopy tool 1000 may be partially withdrawn from, but left ininstrument 100 with the elastomeric gasket and slit valve sealing the fluid chamber and preventing leakage, and thelaparoscopy tool 1000 may be reinserted or fully withdrawn as desired. Then, other tools may be inserted throughinstrument 100.

With reference to FIGS. 10b and 10c, abiopsy forceps assembly 1100 is seen which is a modified version of the biopsy forceps device shown in previously incorporated patent application Ser. No. 07/837,046.Biopsy forceps tool 1100 has adistal end 1112 having ajaw assembly 1114, and aproximal end 1116 having ahandle 1117, aspool 1119, and athumb ring 1121 for manipulation of the jaw assembly. Thejaw assembly 1114 comprises a pair ofjaws 1118 and aclevis 1134. Thejaws 1118 are preferably investment cast, and are preferably a duplicate of the other. Eachjaw 1118 has a proximal end having atang 1124 through which abore 1166 transversely extends. In addition,jaws 1118 each include a secondtransverse bore 1130 through a middle portion of the jaw. Aclevis pin 1128 extends throughbore 1130 and couples to the arms of theclevis 1134. As seen in FIG. 10c, theclevis 1134 extends proximally into ahub 1140 which also receivesmetal tube 1150.Metal tube 1150, as shown in FIG. 10b, is provided with abump 1151 for cautery pickup from the cannula 112 (FIG. 1).

In order for thejaws 1118 to rotate around clevispin 1128, they must be actuated at theirtangs 1124. In particular, a pair ofpull wires 1160 are provided at their distal ends with dog's-leg bend (a Z-bend). Thus, eachpull wire 1160 has afirst portion 1162 which is rotatably disposed in therecess 1126 in thetang 1124 of eachcutter jaw 1118, a second portion 1164 which extends through thebore 1166 in the most proximal end of thetang 1124, and a ninety degree bend 1168 between the second portion 1164 and themain pull wire 1160. Eachpull wire 1160 is also preferably provided with areflex curve 1170 extending between their distalmost ends and the distalmost end of thetube 1150. Thereflex curve 1170 helps to open thecutter jaws 1118 when thespool 1119 on thehandle 1117 is displaced distally thereto.

The proximal end of thetube 1150 and the proximal end of thepull wires 1160 extend intohandle 1117 which is located at theproximal end 1116 of the biopsy forceps assembly 1110. Thehandle 1117 comprises acentral shaft 1121 about which adisplaceable spool 1119 is disposed. Additional details of the handle may be obtained by reference to aforementioned Ser. No. 07/837,046 as they do not comprise an aspect of the present invention. It is of note, however, that movement of thespool 1119, which is disposed about the central shaft, effectuates movement of thepuller wires 1160 disposed within thetube 1150. Because the distal ends of thewires 1160 are attached to thetangs 1124 on thejaws 1118, while the jaws are fixed relative to themetal tube 1150 byclevis 1134 andclevis pin 1128, movement ofspool 1119 causes rotational movement of thejaws 1118.

In use, thejaws 1118 of thebiopsy forceps tool 1100 are inserted in the closed position through theelastomeric gasket 119 and slitvalve 118 and into and through thefluid chamber 114 andcannula 112 of instrument 100 (shown and described above). Upon the distal portion of thebiopsy forceps tool 1100 exiting the cannula ofinstrument 100,jaws 1118 can be opened and closed as described above by movement ofspool 1119. If thebiopsy forceps tool 1100 is sufficiently small in diameter relative to the cannula, suction and irrigation are still available through thecannula 112. In addition, because ofbump 1151, a cautery voltage may be selectively applied to the end effectors (jaws) of theendoscopic tool 1100 viaelectrical contact 132 andcannula 112.

It will be appreciated that the instrument of the present invention offers many advantages when used in endoscopic surgery. After providing an incision in the body and providing a trocar tube therein, theinstrument 100 of the invention can be inserted into the trocar tube to supply irrigation and suction. Moreover, various endoscopic tools and probes can be inserted into the instrument through thefluid chamber 114 andcannula 112 as described above to perform endoscopic procedures while maintaining availability of irrigation and suction through the same body incision. As described, any of these probes or endoscopic tools can also be provided with electrosurgical voltages and currents through the instrument by contact with theelectrical contact 132.

As mentioned in reference to FIGS. 1a and 1b, and in accord with another aspect of the invention, anelectrical supply 150, avacuum 152, and anirrigation supply 154/156 can be connected to the instrument via a single "spinal cord"arrangement 160 where suction and irrigation are in two channels of a single molded plastic tube with a rib therebetween which carries the cautery wires. FIG. 11a shows a cross section of a preferredspinal cord tubing 160 having anirrigation supply tube 130 and alarger suction tube 128 molded together in a single piece with a cylindrical groove orspace 129f for receiving electrical supply wires 129 (FIG. 1a). Thegroove 129f is mostly closed, but is provided with aslit opening 129h defined by a pair oflips 129g extending along the length oftubing 160 so that the electrical supply wires may be inserted into thespace 129f. As seen in FIG. 11a, the size of theopening 129h between the lips is smaller than the diameter ofcylindrical space 129f (and smaller than the diameter of the wire(s) 129). However, because the tubing and lips are elastic, thewire 129 may be forced past the lips and inserted and held in thespace 129f, and remain secure therein although it is still removable therefrom.

FIGS. 11b and 11c show a connector used for coupling thespinal cord tubing 160 to separate suction and irrigation tubes and for holding the electrical supply wires in place at their point of entry intocylindrical space 129f of thetubing 160. The connector comprises acentral block 229 having taperedcouplings 230 and 228 on one side for connection with irrigation andsuction supply tubes 130 and 128, respectively, of thespinal cord tubing 160, and similarly taperedcouplings 230a, 228a on the other side for connection with individualirrigation supply tube 230b andsuction supply tube 228b. The diameter of the couplings may be varied depending on the connections to be made. For example, when the connector is used inside the instrument 100 (134 in FIG. 1b) the inwardly directed tapered couplings may be smaller to connect with tubes inside the instrument.

FIG. 11c shows the connector in cross section along line C-C of FIG. 11b. Here it can be seen that the aforementioned couplings have coaxial throughbores as would be expected and thecentral block 229 is provided with awire space 229f having anopening 229g corresponding to thewire space 129f andopening 129g of thespinal cord tubing 160. Thiswire space 229f provides a convenient place to secure wires entering thespace 129f of thetubing 160. The central block may also be provided with mounting holes, flanges and the like, for securing it in a particular place where the individual tubes and wires are joined to the spinal cord tubing.

FIG. 11d shows an alternate embodiment oftubing 160a withsuction tube 128,irrigation tube 126 and a wire slot orspace 129j. The difference between this embodiment and the one shown in FIG. 11a is that theopening 129k defined bylips 129m is on the opposite side of the tubing; i.e., the flatouter surface 160d oftubing 160 is interrupted by thelips 129m and slot opening 129k as opposed to presenting a flat outer surface as shown in FIG. 11a.

FIGS. 11e and 11f show ahanger clip 260 for securing thetubing 160 to the edge of an operating table or to a hanging post such as those used for IV bottles and the like. Thehanger 260 comprises a resilient strip of metal or plastic shaped to conform somewhat to the round sides of the tubing byrounded portions 260a and 260b terminating incurved ends 260c and 260d. The tube is inserted into the clip by pulling the curved ends 260c and 260d apart and snapping thetube 160 through the space created between these ends. The resiliency of the clip and its conformity to the shape of the tube make it fit snugly around the tube. One end of the clip is provided with a hook likemember 260e for hanging as stated above. Alternatively, the hook-like member 260e may be replaced with a spring-action grasping clamp or an adhesive strip or pad to allow the clip to be attached to the surgical drapes or to the operating table.

Thehanger clip 260 or the like may also be used in conjunction with the tubing embodiments seen in FIGS. 11g and 11h. In FIG. 11g, a moldedtubing 1560 is provided with asuction tube 1528, and anirrigation tube 1530. The tubes are joined at athin junction 1570 which is defined by the meeting of the suction and irrigation tubes atpoints 1571a and 1571b. As seen in FIG. 11g, thethin junction 1570 is made sufficiently narrow such that the suction and irrigation tubes can be peeled apart. In addition, as seen in FIG. 11g, the irrigation tube has resilient extensions orlips 1540a, and 1540b which help define alumen 1529 for a cautery cable having anopening 1540c which is smaller than the diameter of the cautery wire to be held in the lumen. In this manner, the wire (not shown) can be snapped into place and held in place, or removed as desired. It will be appreciated that the resilient lips are provided on the irrigation tube because the irrigation tube is preferably smaller than the suction tube, and so the overall diameter of the tube portion housing the irrigation tube and cautery lumen will be relatively close in size to the size of the suction tube portion. Of course, if desired, the lips defining the cautery lumen could be provided on the suction tube rather than on the irrigation tube.

Turning to FIG. 11h, atubing 1660 which is similar to that of FIG. 11g is provided, except that instead of providing an integral single plastic tubing, twotubes 1628 and 1630 are provided.Suction tube 1628 is shown withlips 1671a and 1671b which define a thin channel.Irrigation tube 1630 is shown with a protrusion orknob 1670 which mates with the thin channel along its length. In this manner, the irrigation tube andsuction tube 1628 are held together, but can easily be divided as shown. As with the embodiment of FIG. 11g, thesuction tube 1630 is also provided withresilient lips 1640a and 1640b which define alumen 1629 for a cautery cable, with the lumen having anopening 1640c which is smaller than the diameter of the cautery cable. In this manner, the cautery cable can be snapped into place, or divided out from the irrigation lumen as desired.

Thetubings 160, 160a of FIGS. 11a and 11d (as well astubings 1560 and 1660 of FIGS. 11g and 11h) provide a distinct advantage over the prior art in that a jumble of wires andtubes exiting instrument 100 is avoided. In addition, by providing a clip such as shown in FIGS. 11e and 11f, issues regarding the sterile field can be avoided, as the clip can be positioned at a point on operating room table where sufficient length of tubing for flexibility is provided, and that tubing will all be maintained in the sterile field, while all tubing beyond the clip will be assumed to be located out of the sterile field.

As mentioned above in reference to FIG. 1a, and according to a further aspect of the invention, a T-ball valve is provided to couple two sources of irrigation fluid to a single irrigation supply tube. FIGS. 12a-12e show details of such a T-ball valve, and it can be seen that the T-ball valve 158 preferably comprises threefluid chambers 952, 958, and 964 and aball chamber 960.Ball chamber 960 is separated fromfluid chamber 952 by ashoulder 954 having aninclined edge 956 facingball chamber 960 so that theball 972 will not enterfluid chamber 952 but may sealingly seat against theinclined edge 956 ofshoulder 954.Ball chamber 960 is separated from thefluid chamber 964 by a narrow connectingpiece 962 which is shown clearly in FIG. 12b (which is a cross section along line B--B of FIG. 12a) and is provided so that the ball will not enterchamber 964. Of course, other means such as bumps or protrusions (i.e., partial connecting pieces 962) can be used for this same purpose. In the preferred embodiment,fluid chamber 958 is dimensioned to be larger thanfluid chamber 952 so that it can receive an insert 966 (FIG. 12d) after theball 972 is placed in theball chamber 960. Theinsert 966 has inner dimensions similar to thefluid chamber 952 with ashoulder 968 having aninclined edge 970 facingball chamber 960 so that theball 972 will not enterfluid chamber 958 but will sealingly seat againstinclined edge 970. As shown in FIG. 12e,ball 972 is seated againstinclined edge 956 thereby sealing offfluid chamber 952 so that fluid fromchamber 958 may enterchamber 964 without enteringchamber 952. It will be appreciated that whenball 972 is in its opposite position againstinclined edge 970, fluid fromchamber 952 may enterchamber 964 without enteringchamber 958.

Referring back to FIG. 1a, it will be appreciated that when theirrigation fluid supply 156 is opened to enter T-ball valve 158, theball 972 in the valve will seat againstinclined edge 970 sealing thefluid chamber 958 so that fluid fromfluid source 156 does not enter the tube leading tofluid source 154. When fluid influid source 156 is exhausted andfluid source 154 is opened, theball 972 will be forced by thefluid entering chamber 958 to seat againstinclined edge 956 thereby sealingchamber 952 and preventing fluid fromfluid source 154 from enteringfluid source 156.

As mentioned in reference to FIG. 1b, theshell 102 ofinstrument 100 includes trigger switches operating valves for suction and irrigation. One type of valve was shown and discussed in reference to FIGS. 3a and 3b. FIGS. 13a -13c and 13d-13e show two other types of valve arrangement which can be used with alternate embodiments of fluid chamber as will be discussed in detail below with reference to FIG. 14a and 14b.

Referring now to FIGS. 13a and 13c, avalve assembly 1300 includes asuction conduit 1302 which is coupled to a vacuum source (not shown), anirrigation conduit 1304 which is coupled to a source of irrigation fluid (not shown), andsingle port 1306 connected to thefluid chamber 1414a (FIG. 14a), and twopoppets having disks 1308 and 1310, and stems orrods 1312 and 1316.Valve disks 1308 and 1310 are preferably provided with 0-ring seals 1309, 1311 around their outer surfaces.Valve disk 1308 is shown in the path which connects thesuction conduit 1302 withport 1306, andvalve disk 1310 is shown in the path which connects theirrigation conduit 1304 withport 1306 via Connecting space orchamber 1320. Thepoppet valve disks 1308 and 1310 are operable by poppet valve stems orrods 1316 and 1312 which are biased bysprings 1377 and 1379 in the triggers (see FIG. 1b). Thus, the suction trigger 104 (FIG. 1b) is attached to stem 1312 to operatepoppet valve disk 1308, andirrigation trigger 106 is attached topoppet stem 1316 to operatepoppet valve disk 1310. Thevalve assembly 1300 includesholes 1381, 1383 andchambers 1385, 1387 housing 0-rings 1391, 1393 through which the stems 1312, 1316 extend, to prevent leakage out through the trigger mechanism.

By comparing FIGS. 13a and 13b, it is seen thatirrigation valve disk 1310 is movable from a first position shown in FIG. 13a whereirrigation conduit 1304 is sealed from the fluid chamber 1320 (and hence from fluid port 1306) to a second position shown in FIG. 13b. In FIG. 13b, the irrigation fluid passes frominlet 1304 tochamber 1320 and, ifvalve seal 1308 is in the closed position as it is in FIG. 13a, up intoport 1306. Likewise,suction valve disk 1308 is movable from a first position shown in FIG. 13a where thesuction conduit 1302 is sealed from theport 1306 to a second position shown in FIG. 13b where thesuction conduit 1302 communicates with theport 1306, andchamber 1320 is sealed off from theport 1306. It is noteworthy that when the suction trigger is fully depressed, the chamber is sealed off so that no suctioned material enterschamber 1320 to be later mixed with irrigation fluid and/or clog the valve. If desired, a seat 1324 (shown in phantom) may be provided as a back stop fordisk 1308 in order to provide a more secure closure against the possibility of suctionedmaterials entering chamber 1320. It should be appreciated, that with the valve assembly arrangement of FIGS. 13a-13c, that if it is desired to clean thechamber 1320 and/orsuction conduit 1302, the triggers for the suction and irrigation may be pressed at the same time, with the suction valve only partially opened. This will cause a flow fromirrigation conduit 1304 pastvalve disk 1310 and intochamber 1320, and then around andpast valve 1308 and downsuction conduit 1302.

Thefluid chamber 1414a of FIG. 14a, which in most respects is the same asfluid chamber 114 discussed above with reference to FIGS. 1b, and 4a-4b, is provided for thevalve assembly 1300 of FIGS. 13a-13c. As seen in FIG. 14a,fluid chamber 1414a has a single combined suction-irrigation port 1306. The provision of a fluid chamber with a single port for both suction and cautery permits the fluid chamber, and thus the entire instrument to be made smaller.

FIGS. 13d and 13e show yet another embodiment of a poppet valve assembly which may be used with yet another embodiment of thefluid chamber 1414b of FIG. 14b which will be discussed in below. The embodiment of FIGS. 13d and 13e is similar to the arrangement of FIGS. 13a-13c, except that in this embodiment, there are twoports 1340a and 1340b leading tofluid chamber 1414b, and nocommon chamber 1320. In particular, a suction poppet valve, having adisk 1308 and astem 1316 is provided in the path ofsuction conduit 1302, 1332a.Suction conduit 1304 is coupled to a vacuum source (not shown), and the conduit outlet 1332a is coupled viafluid chamber port 1340a to thefluid chamber 1414b.Poppet valve disk 1308 is biased in a closed position byspring 1377 which is connected to trigger 104 (see FIG. 1b), and thedisk 1308 is provided with an O-ring 1309 to seat in the normally closed position against aseat 1341a at one end of thevalve chamber 1319a.Valve chamber 1319a is provided to permit the travel ofdisk 1308 out of thesuction conduit path 1322a, 1302.

The irrigation system in the poppet valve assembly of FIGS. 13d and 13e is similar to the suction system. An irrigation valve, having adisk 1310 and astem 1318 is provided in the path ofirrigation conduit 1304, 1322b. Irrigation conduit is coupled to an irrigation source (not shown), and theirrigation outlet 1322b is coupled viafluid chamber port 1340b to thefluid chamber 1414b.Poppet valve disk 1310 is biased in a closed position byspring 1379 which is connected to trigger 106 (see FIG. 1b), and thedisk 1310 is provided with an 0-ring 1311 to seat in the normally closed position against aseat 1341b at one end of thevalve chamber 1319b.Valve chamber 1319b is provided to permit the travel ofdisk 1310 out of theirrigation conduit path 1322b, 1304.

As seen in FIGS. 13d and 13e, thesuction port 1340a is angled relative tofluid chamber 1414b, while the irrigation is not so angled. The angle ofsuction port 1340a is purposely provided so that the flow through theport 1340a, the outlet 1332a, andconduit 1304 is a straight path. In this manner, clogging of the port or conduit is best avoided. Also, the manufacturing process will be considerably easier. On the other hand, because the irrigation path will not clog, the tortuousness of the path is not of particular concern. Thus, the irrigation path is chosen simply to reduce the size of the apparatus.

FIG. 14b shows anotherfluid chamber 1414b which is in most respects the same asfluid chamber 114 discussed above, but whereirrigation conduit port 1340b enters from the bottom andsuction port 1340a enters in an angled manner from the side. The angled suction port configuration permits an offset between fluid conduits which eliminates suction flow path tortuousness, and provides a compact assembly.

There have been described and illustrated herein several embodiments of an endoscopic suction-irrigation instrument with electrosurgical capabilities, probes for use with the instrument, valves, circuits, switches, and connectors. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while a particular pistol shape for the instrument shell has been disclosed, it will be appreciated that many other shapes could be used with similar results. Also, while particular configurations of triggers and switches have been shown, other actuating means may easily be adopted for use with the invention. Moreover, while the fluid chamber has been described in several embodiments as including a locking pin, an electrical contact and a slit valve, it will be appreciated that the locking pin and electrical contact could be provided outside the fluid chamber and other types of valves could be substituted for the slit valve, even though the slit valve is particularly advantageous. Further, while several different probes, each with different features have been disclosed, it will be appreciated that the features of different probes may be combined in many different ways to provide even more types of probes for use with the invention. Likewise, while particular endoscopic and laparoscopic tools were shown as modified for insertion into the suction/irrigation instrument of the invention so as to effect cautery, it will be appreciated that the instruments need not be modified, and that numerous other tools could be used in conjunction with the suction/irrigation instrument of the invention, with or without modification as desired. Further yet, while it will be appreciated that the preferred materials for the tubing of the disclosed instrument is Kraton (a thermoplastic elastomer), and that the preferred materials for the fluid chamber, shell, triggers, etc. is ABS (acrylonytrile butadiene styrene), other materials could be utilized. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as so claimed.

Claims (17)

What is claimed is:

1. An endoscopic suctioning instrument, comprising:

a) a hollow cannula having a proximal end and a distal end;

b) a sliding sleeve having a proximal end and a distal end and a longitudinal axis, said sliding sleeve being coaxial to and closely surrounding and slidingly engaging said hollow cannula, said sliding sleeve having a plurality of lateral holes at its distal end with said lateral holes being spaced along said longitudinal axis;

c) valve means for selectively coupling a suction source to said proximal end of said cannula;

d) sleeve actuation means means coupled to said sliding sleeve for sliding said sliding sleeve from a first position where said distal end of said sliding sleeve extends beyond said distal end of said cannula such that a first number of said plurality of lateral holes are unblocked by said cannula, to a second position where said distal end of said sliding sleeve extends beyond said distal end of said cannula such that a second number of said plurality of lateral holes are unblocked by said cannula, said second number being less than said first number, to a third position where said cannula blocks all of said lateral holes of said sliding sleeve;

e) valve actuation means coupled to said valve means for opening and closing said valve means,

wherein the sliding of said sliding sleeve from said first position to said second position to said third position when said suction tube is coupled to said cannula by said valve means, incrementally increases suction through said distal end of said sleeve as said lateral holes are sequentially blocked by said hollow cannula; and

f) cooperation means acting between said sleeve actuation means and said valve actuation means such that actuation of one of said sleeve actuation means and said valve actuation means is effected by actuation of the other one of said sleeve actuation means and said valve actuation means.

2. An endoscopic suctioning instrument according to claim 1, wherein:

said cooperation means comprises a collar, on said sleeve actuation means, having a radial extension, and

said cooperation means further comprises an engagement means, on said valve actuation means, for engaging said radial extension of said sleeve actuation means, wherein

said valve actuation means is movable from a first valve position in which a connection between said suction source and said cannula is closed, to a second valve position in which said connection between said suction source and said cannula is at least partially open but said engagement means does not engage said radial extension of said collar, to a third valve position in which said engagement means engages said radial extension of said collar and incrementally to a fourth valve position with said engaging means engaging said radial extension in which said lateral holes are sequentially blocked by said hollow cannula.

3. An endoscopic suctioning instrument according to claim 2, wherein:

said collar is located at a proximal portion of said sliding sleeve.

4. An endoscopic suctioning instrument according to claim 2, further comprising:

a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.

5. An endoscopic suctioning instrument according to claim 2, wherein:

said valve actuation means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means extending from said trigger means along an axis parallel to said longitudinal axis.

6. An endoscopic suctioning instrument according to claim 1, wherein:

said cooperation means comprises a collar, on said sleeve actuation means, having a radial extension, and

said cooperation means further comprises an engagement means, on said valve actuation means, for engaging said radial extension of said sleeve actuation means, wherein

said valve actuation means is movable from a first valve position where said engagement means does not engage said radial extension and a connection between said suction means and said cannula is closed by said valve means, to a second valve position where said engagement does not engage said radial extension and said connection between said suction means and said cannula is at least partially open, to a third valve position where said engagement means engages said radial extension and said sliding sleeve is in said second position.

7. An endoscopic suctioning instrument according to claim 6, further comprising:

a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.

8. An endoscopic suctioning instrument according to claim 6, wherein:

said engagement means comprises a first radial extension, said first radial extension being distal and spaced from said radial extension of said collar when said sleeve actuation means is in said first position.

9. An endoscopic suctioning instrument according to claim 8, wherein:

said valve means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means having a longitudinal portion extending from said trigger means along an axis parallel to said longitudinal axis, and said first radial extension extending radially from said longitudinal portion.

10. An endoscopic suctioning instrument according to claim 9, wherein:

said engagement means further comprises a second radial extension, said second radial extension being spaced from said first radial extension, and said second radial extension being proximal said radial extension of said collar.

11. An endoscopic suctioning instrument according to claim 10, further comprising:

a spring means seated against said collar and spring loading said sliding sleeve in a distal direction.

12. An endoscopic suctioning instrument according to claim 1, wherein:

said valve actuation means is movable from a fully open position to a fully closed position independently of said sleeve actuation means, and

said cooperation means comprises a flange, on said sleeve actuation means, means for contacting a portion of said valve actuation means and moving said valve actuation means.

13. An endoscopic suctioning instrument according to claim 12, wherein:

said flange means contacts said valve actuation means such that said valve actuation means moves whenever said sleeve actuation means is actuated.

14. An endoscopic suctioning instrument according to claim 13, wherein:

said sleeve actuation means comprises a collar having a radial extension, and

said valve actuation means includes engagement means for engaging said radial extension of said sleeve actuation means.

15. An endoscopic suctioning instrument according to claim 12, wherein:

said sleeve actuation means comprises a collar having a radial extension, and

said valve actuation means includes engagement means for engaging said radial extension of said sleeve actuation means.

16. An endoscopic suctioning instrument according to claim 15, further comprising:

a spring means seated against said collar and spring loading said sliding sleeve in a distal direction, wherein

said collar is located at a proximal portion of said sliding sleeve.

17. An endoscopic suctioning instrument according to claim 16, wherein:

said valve actuation means comprises a trigger means, wherein said trigger means includes said engagement means, said engagement means extending from said trigger means along an axis parallel to said longitudinal axis.

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